Missouri’s Attorney General recently announced that a skilled nursing facility would pay $150,000 in fines and civil money penalties related to their filing of false claims to Medicaid. From May 1, 2018, through September 1, 2018, an investigation by the state’s Medicaid Fraud Control Unit Fund found that the facility submitted 38 claims for reimbursement of per diem daily care services to three residents for care that was not provided.
The false claims resulted from the abuse and neglect of three residents with pressure ulcers or bedsores—two of residents’ wounds were reported to be extremely deep and severe.
The nursing facility’s failure to provide treatment and to document that it provided necessary care to residents, including all treatment, services, and supplies, for which it billed Medicaid, constitutes a false claim for each date of service.
Compliance Perspective
Issue
Failing to prevent residents from developing severe, deep pressure ulcers due to neglecting to provide the care needed for prevention and proper treatment may be deemed abuse, neglect, and provision of substandard quality of care that is immediate jeopardy for harm. Submitting claims for services that were knowingly not provided violates the False Claims Act and may result in civil money penalty assessments.
Discussion Points
- Review policies and procedures regarding provision of care to prevent, treat, and heal pressure ulcers, including the involvement of a wound care provider.
- Train staff on abuse and neglect and the protocols they should follow to prevent development of pressure ulcers, and proper wound care for healing of existing wounds.
- Periodically audit to determine if protocols for preventing and treating/healing pressure ulcers are in place and being followed.
